Affidavit of Loss

Here is a basic format or sample of an Affidavit of Loss. This form can be modified if you loss an ID or other documents. It is important that you consult a lawyer to help customize this affidavit to your own circumstances.

AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES )
_____________________________ ) SS.

I,              state your full name           , Filipino, of legal age,             single/married to     state name of husband or wife if married       , and a resident of         state resident address        , after having been duly sworn in accordance with law, hereby depose and say:

1. That I am a holder of a (school/company)  identification card with number _____________________________ issued by _____________________________;

2. That I regularly keep the said identification card in my wallet, among others;

3. That sometime in state date when permit/official document was lost, when I arrived home from work, I discovered that said ID card was no longer in my wallet;

4. That despite diligent effort to locate the same I could not find it;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a replacement of said ID from the _____________.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ________,  2014 at _____________, Philippines.


                                                                     _____________________
                                                                                 AFFIANT

                                                                                            (Affix signature of Affiant over printed name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________ this ____ day of (month), 2014 at (City/Municipality), affiant exhibiting to me his valid government-issued identification no. _______________ issued at _________________ and valid until ______________, and personally signed the foregoing instrument before me and avowed under penalty of law as to the whole truth of the contents of said instrument.

                                                                                      Notary Public

                                                                                      Until 31 December 20___

                                                                                      PTR No. __________

                                                                                      Issued at: __________

                                                                                      Issued on: __________

                                                                                      TIN No. ___________

Doc. No. _______

Page No. _______

Book No. _______

Series of ________

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Hi! I'm a law student from Manila, Philippines.  I did Political Science, then Industrial Relations major in H.R. (postgrad) studies from UP.  I vlog, weightlift, experiment with new makeup looks, try Bollywood and bellydance steps, and rant about my cray life in my YouTube channel.  Once in a blue moon, I create content for another YT channel,  10+ blogs,  20+ FB pages and in HubPages.  Check out my official site.